SOME of India’s privately-held hospital chains are growing much faster than the listed Apollo Hospitals, the second-largest player in the space, signalling a growing fragmentation in the upper strata of the $46-billion industry. Fortis Healthcare, however, appears well-ensconced at the top slot for now.

According to filings with the Registrar of Companies, among the unlisted firms that have increased their market share between FY11 and FY13 are two Bangalore-headquartered firms — Narayana Hrudayalaya and Manipal Health Enterprises (see chart).

Delhi-based Fortis Healthcare has entrenched its top slot in the hospital industry with revenue of R4,243 crore in FY13, up 42.1% over the previous year, which in turn saw a jump of about 100% in revenue. In comparison, Chennai-based Apollo’s revenue grew 18.42% to R3,349 crore in FY13 and 20.36% in the year before.

With listed entities such as Apollo and Fortis maintaining their focus on metros and Tier-I cities, unlisted private hospital chains spent their energies to try and capture markets in Tier-II and III towns, drawn by the relatively cheaper real estate and lower levels of competition. According to a JPMorgan report, investment per bed in Tier-II/III cities is nearly 50% lower than in metros and Tier-I cities.

Fortis posted the highest post-tax profit among Indian hospital chains of nearly R500 crore in FY13, up 592% over the previous year, which, incidentally, saw a 42% decline in profits as the company took a one-time cost of acquiring an 86% stake in India’s largest diagnostics player, Super Religare Laboratories for about R930 crore in May 2011.

Hospitals contribute to nearly 71% of the $80-billion Indian healthcare industry with the private sector dominating the landscape with an approximate 82% market share. “Given the fairly limited government spending (restricted mostly to rural areas), we believe the growing demand-supply gap will continue to pull private investments. In our view, over the next 10-15 years, investment of about $70 billion is required to meet the additional demand of the healthcare services in the country,” the JPMorgan report dated December 10 said.

In its filing with the RoC, it said that it plans to build additional capacity and extend the reach of entering new locations in the coming years. “Further, in the next one year, the existing bed capacity would be enhanced by about 200 beds and several other projects (would commence)